Clinicopathological variations between early and late recurrence in bladder cancer post-radical cystectomy.

Abstract

874 Background: Over 50% of patients diagnosed with muscle-invasive bladder cancer are estimated to experience urothelial cell carcinoma (UCC) recurrence following radical cystectomy (RC). Current studies have found clinicopathological factors associated with overall UCC recurrence; however, there is a lack of data on variations between patients with early versus late recurrence. This study examines the clinicopathological differences of these cohorts. Methods: Within our single institutional IRB-approved cystectomy database, we reviewed 1,050 patients from 1971 - 2023 who underwent RC with intent to cure for primary UCC and experienced recurrence at the University of Southern California. Patients included had documented recurrence via biopsy or imaging. Patients with distant metastasis at RC were excluded. Clinicopathological factors were chosen based on significance in prior studies. Early recurrence (ER) was defined as within two years of cystectomy, the most common time frame for UCC, and late recurrence was beyond two years. Cox regression and chi-squared tests were utilized to compare the groups. Results: Among 1,050 patients, the median age was 68. Of the 928 open cystectomies, 73.2% had ER, compared to 87.7% of the 122 robotic cystectomies. ER rates were 71.9% for the 588 orthotopic diversions, 69.9% for the 143 continent diversions, and 82.5% for the 319 incontinent diversions. Factors predictive of ER included older age (OR = 1.582, p = 0.0017), higher Charlson Comorbidity scores (OR = 1.460, p = 0.0112), higher ASA scores (OR = 1.900, p = 0.001), hydronephrosis prior to RC (OR = 1.944, p = <0.0001), lymphovascular invasion (OR = 1.472, p = 0.0383), lymph node involvement at RC (OR = 2.770, p = <0.0001), neoadjuvant chemotherapy (OR = 3.457, p = <0.0001), incontinent urinary diversions (OR = 1.832, p = 0.0008), greater than pT3 pathological staging (p = <0.0001), and variant histology (OR = 1.782, p = 0.0006). Conclusions: This study identifies clinicopathological risk factors significantly associated with ER. By describing these factors, this study aims to improve predictions of UCC recurrence patterns and inform personalized treatment. Further research is needed to validate our findings and optimize surveillance protocols for at risk patients. Multivariate analysis of variables predictive of early recurrence. Variable Hazard ratio p-value Age > 70 1.464 (1.054 - 2.042) 0.0238 Pre-operative Albumin 0.990 (0.981 - 0.999) 0.0227 Neoadjuvant Chemotherapy 3.527 (2.187 - 5.930) <0.0001 Pathological Staging Organ - Confined Extravesical Lymph Node Positive Ref4.511 (2.955 - 7.024)7.553 (5.000 - 11.636) <0.0001 Urinary Diversion Orthotopic Diversion Continent Diversion Incontinent Diversion Ref0.807 (0.513 - 1.281)1.459 (1.003 - 2.139) 0.0531 Adjuvant Chemotherapy 0.568 (0.372 - 0.863) 0.0083